| NPI | 1679607626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS 26064) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.014422) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2013-09-18 |